Provider Demographics
NPI:1801612130
Name:PELLEGRINO, ANNIE (RN)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 BORDEN AVE APT 3J
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5885
Mailing Address - Country:US
Mailing Address - Phone:917-940-8875
Mailing Address - Fax:
Practice Address - Street 1:549 BORDEN AVE APT 3J
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5885
Practice Address - Country:US
Practice Address - Phone:917-940-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY812524163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical